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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page ` of <br /> Facility#: Q'8 City: L -�-� ,harp Testing Contractor: � ar �,��,yt_ Test Bate: -02- <br /> Facility <br /> 0ZFacility Address: s E ��tLi�� Contractor Addressk 7 y7 IS Ea 'tGa, G+ Tech.Name; GTtp.�Utp <br /> I <br /> I i <br /> Turbine Sumps 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Fill Sumps 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> 1D(north,slave,etc.) 1D north slave etc. <br /> Manufacturer Manufacturer <br /> Start Time(to) Start Time(to) <br /> Water Level Water Level <br /> Time (t,) Time(t,) <br /> ater Level Water Level <br /> Time(t2) Time 02) <br /> Water Level Water Level <br /> Time(t3) Time 03) <br /> Water Level Water Level <br /> Time 44) Time 04) j <br /> Water Level Water Level ! <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail Test Resul Pass Fail Pass Fail P�ss Fail Pass F it001 <br /> ; <br /> Signature Signature <br /> I <br /> UDC 3/ UDC <br /> I <br /> 1D(1/2,3/4,etc.) ID(1/2,314,etc.) <br /> Manufacturer Manufacturer <br /> art Time(to) I "0-V Start Time(to) <br /> Water Level 0. Water Level <br /> Time(t,) 111.03 Time(t,) <br /> Water Level 0.ODD Water Level <br /> Time(t2) ",' 0� Time 02) <br /> Water Level .L'?0z) Water Level <br /> Time(0 ' O9 Time(t3) <br /> Water Level ©-wo Water Level <br /> Time(t4) I 1 1 �L Time(t4) A <br /> Water Level 0, wo Water Leve <br /> Test Results Pass Fail PasFail Pass Fail Pass Fail Test tfults Pass Fail Pass Fail P�ss Fail Pass z <br /> Signature 1 Signature <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor <br />